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Despite the events that occurred at the 2013 Boston Marathon (Boston, Massachusetts USA), there are currently no evidence-based guidelines or published data regarding medical and disaster preparedness of marathon races in the United States.
To determine the current state of medical disaster preparedness of marathons in the US and to identify potential areas for improvement.
A cross-sectional, questionnaire-based study was conducted from January through May of 2014. The questionnaire was distributed to race directors of US road and trail marathons, as identified by a comprehensive internet database.
One hundred twenty-three questionnaires were available for analysis (19% usable response rate). Marathon races from all major regions of the US were represented. Runner medical information was not listed on race bibs in 53% of races. Only 45% of races held group training and planning sessions prior to race day. Automated external defibrillators (AEDs) were immediately available on 50% of courses, and medications such as albuterol (30%), oxygen (33%), and IV fluids (34%) were available less frequently. Regarding medical emergencies, 55% of races did not have protocols for the assessment of dehydration, asthma, chest pain, syncope, or exercise-induced cramping. With regard to disaster preparedness, 50% of races did not have protocols for the management of disasters, and 21% did not provide security personnel at start/finish lines, aid stations, road crossings, and drop bag locations.
Areas for improvement in the preparedness of US marathons were identified, such as including printed medical information on race bibs, increasing pre-race training and planning sessions for volunteers, ensuring the immediate availability of certain emergency equipment and medications, and developing written protocols for specific emergencies and disasters.
GlickJRixeJASpurkelandNBradyJSilvisMOlympiaRP. Medical and Disaster Preparedness of US Marathons. Prehosp Disaster Med. 2015;30(4):1–7.
Anxiety is both an innate and a constructed response to perceived and anticipated threat. This chapter explores anxiety as signal, symptom and syndrome, and describes the evolution of the major psychodynamic models of signal anxiety. The major psychodynamic models of signal anxiety posit anxiety as a signal of unconscious, intrapsychic danger. Neurobiological factors also contribute to the development and expression of anxiety symptoms and syndromes. Imaging techniques have been used to illustrate the presence of unconscious processes that to date have only been hypothesized; specifically that unconscious affects are a crucial determinant of behavior. Many symptomatic patients were forced to make adaptations to internal and external threats in early childhood. Ironically, the treatment of symptomatic anxiety may create an anxiety of its own, the anxiety about change. Many patients present with the acute onset of anxiety symptoms but do not meet the criteria for an Axis I anxiety disorder.
We describe and illustrate the use of a generalizable model for evaluating the cost-effectiveness of alternative cholesterol-lowering treatments. We combine standard incidence-based techniques for measuring the cost of illness with logistic risk functions from the Framingham Heart Study to project, for persons with known coronary risk characteristics, the likelihood of developing coronary heart disease (CHD) over a lifetime as well as a number of related outcomes, including the expected loss of years of life due to CHD, the expected lifetime direct and indirect costs of CHD, and the changes in these outcomes that would result from cholesterol-lowering treatment.
Background. We report here a study examining the relationships between insight and psychopathology, cognitive performance, brain volume and co-morbid depression in 251 patients experiencing a first episode of psychosis, who were then randomly assigned to 2 years of double-blind treatment with either olanzapine or haloperidol.
Method. Repeated measures of insight were obtained at baseline and 12, 24, 52 and 104 weeks by the Insight and Treatment Attitudes Questionnaire (ITAQ).
Results. Older age, female gender and white ethnicity were associated with more insight. Higher total, positive, negative and general psychopathology scores on the Positive and Negative Syndromes Scale (PANSS) were associated with less insight. Higher depression scores were associated with more insight. Better neurocognitive function and large brain volumes were associated with more insight. More insight throughout the study was associated with longer time to medication non-adherence. However, baseline insight was not significantly related to the probability of discontinuing the study before 2 years. Insight improved significantly over the course of the study, but the improvement in insight was not significantly different between the two antipsychotic treatment groups.
Conclusions. Multiple factors contribute to insight. Patients experiencing a first episode of psychosis who have little insight are at increased risk of discontinuing their medication.
The attainment of universal suffrage over various forms of voting restrictions has been one of the major accomplishments in the development of modern democratic institutions. Struggles for the vote have had to overcome restrictions based on factors such as sex, race and tenure of property. While gaps in the exercise of the franchise still remain, formal restrictions on voting in the United States have been largely removed.
However, an important question, largely uninvestigated, concerns the “costs” of the universal franchise in terms of the quality of government and its impact upon policy decisions. Do the disadvantages of universal suffrage offset advantages said to be gained, particularly in Western nations, such as increased legitimization of decisions and stability of regimes? Many of the past and present opponents of the extension of voting have argued that the poor results to be expected from the impact of universal suffrage far outweigh the advantages. Clearly, the problem of “costs” is important, for it is a crucial element in the argument over democracy and the vote.
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